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The impact of war on ACS admissions and triage - a single center experience
Sharon Bruoha1, Tatiana Stolichny1, Vladimir Chitoroga1
1Department of Cardiology, Barzilai University Medical Center, Ashkelon and Faculty of Health Science, Ben-Gurion University of the Negev, Israel.
Insights
War significantly reduced acute coronary syndrome (ACS) admissions, but patient outcomes remained stable. Effective management of ACS is achievable even during conflict with systematic approaches and heightened awareness.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Data on war's impact on cardiovascular disease is limited.
- The Israel-Gaza war (Oct 7, 2023 - Jan 6, 2024) offers insight into war's effects on acute coronary syndrome (ACS).
Purpose of the Study:
- To investigate the influence of war on the epidemiology, characteristics, and management of ACS patients in active conflict zones.
Main Methods:
- Retrospective analysis of ACS patients admitted between Oct 7, 2023, and Jan 6, 2024.
- Collected data on critical time intervals, in-hospital, and 30-day outcomes.
- Compared findings with ACS cases from the pre-war period.
Main Results:
- A total of 449 ACS patients were analyzed (358 pre-war, 91 during war).
- Monthly ACS admissions decreased significantly during the war (28.79 vs. 38.91, p < 0.001).
- Ischemic times for ST-elevation myocardial infarction (STEMI) remained similar (179 min vs. 187 min, p = 0.849).
Conclusions:
- War dramatically impacts cardiovascular disease incidence but not necessarily admission rates.
- Effective management of ACS patients is feasible during wartime with systematic approaches and increased awareness, despite resource limitations.
Introduction:
Contemporary data regarding the impact of war on cardiovascular disease is scarce. The Israel-Gaza war that erupted on October 7th, 2023, provided a tragic opportunity to explore the effect of war on the epidemiology, characteristics, and management of patients with acute coronary syndrome (ACS) living in areas of active armed conflict.
Methods:
All patients admitted with ACS to our medical center, between October 7th, 2023, and January 6th, 2024, were retrospectively included. Crucial time intervals in the management of individuals with ACS were collected in a predetermined spreadsheet. In-hospital and 30-day outcomes were obtained from the medical records and contrasted with ACS cases admitted in the period preceding the war.
Results:
A total of 449 individuals (102 females [22.7 %]) with a diagnosis of ACS were recruited, 358 patients (144 STEMI and 214 NSTEMI) were admitted during the 9 months before October 7th and 91 patients (42 STEMI and 49 NSTEMI) in the 3 months after October 7th. Compared to the control period, a significant reduction in ACS admissions per month was noted (38.91 vs. 28.79, p < 0.001) driven by fewer cases of both STEMI and NSTEMI (15.65 vs. 13.29, p = 0.011 and 23.26 vs. 15.5, p < 0.001, respectively). In patients with STEMI, the total ischemic time was similar before and after the war (179 min vs. 187 min, p = 0.849).
Conclusions:
War has a dramatic impact on cardiovascular incidence and outcomes which, however, are not necessarily linked to higher admission rates. Nevertheless, with the adoption of systematic approach and increased awareness, patients with ACS can be managed effectively even at times of extremely limited resources such as war.
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